Papers of April

Here’s a look at some of the papers that caught our eye this month. We cover the best way to diagnose heart failure, the risks associated with hyperopia and the utility of ETCO2.  Take the time to have a look at the papers yourself and leave any feed back or comments at the bottom of the page.

The Papers

Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Martindale JL. Acad Emerg Med. 2015 Dec 21. doi: 10.1111/acem.12878. [Epub ahead of print]

Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction.Nehme Z. Heart. 2016 Mar;102(6):444-51. doi: 10.1136/heartjnl-2015-308636. Epub 2016 Jan 6

Prognostication of out-of-hospital cardiac arrest patients by 3-min end-tidal capnometry level in emergency department. Poon KM. Resuscitation. 2016 Mar 3;102:80-84. doi: 10.1016/j.resuscitation.2016.02.021. [Epub ahead of print]

Within the podcast we talk about the fantastic ultrasound resource that is 5min sono developed by Jacob Avila, make sure you got over to the site and have a look at the superb ultrasound resources on offer. Specific to this podcast is the episode on b lines, Jacob kindly provided the images below from his video.

What’s required to identify significant B-lines on chest ultrasound; summary of Jacobs point

  • Use the phased array probe ideally, curved linear probe is possible but technically more difficult
  • Patient position; choose any that allows access to the chest
  • Probe marker towards patients head
  • Scan 4 zones to each side of the chest, superior medial, superior lateral, inferior medial, inferior lateral

Screen Shot 2016-03-15 at 07.53.23

  • To diagnose b lines you need to see vertical artefact, moving with respiration that extends the full depth of the screen (as shown below)

Screen Shot 2016-03-15 at 07.59.38

  • A positive zone is when you identify 3 b-lines in a zone
  • Pulmonary oedema diagnosed with 2 positive zones on each side of the chest

Related Resources


PHEMCAST Hyperoxia 





3 thoughts on “Papers of April

  1. Tom Roper says:

    I listen to your podcast with great interest; it helps me a great deal in my work as a Clinical Librarian working with an emergency department. I was interested in your appraisal of the Martindale paper, so decided to check the way in which the authors had found the papers they included, which makes or breaks a systematic review.
    The search strategy is not fully reported, but the authors would appear to have searched using MeSH terms only. Systematic review searches should use a combination of controlled vocabulary and natural language terms; this is particularly important in order to retrieve new citations added to databases, which will not yet have been fully indexed and search terms added. Further, though they also searched EMBASE, they do not report that they adapted their strategy to the EMTREE thesaurus, which EMBASE uses.
    Neither do they report the date on which searches were executed, nor the platform used to search EMBASE.
    These points may seem pedantic, but, in the absence of clear search reporting, and a comprehensive strategy, the review’s claim to be systematic is questionable.

  2. sl says:

    Thanks very much for your reply Tom, you’re obviously an expert in this area and it’s really useful as a clinician to get feedback like this so many thanks.

    Out of interest how many papers of relevance do you think this way of searching will have missed out on in their review?


  3. Tom Roper says:

    I did leave a reply a few days ago, but it hasn’t appeared yet. Without a replicable strategy, it’s hard to predict how many papers would have been missed. The reasons for the two-pronged natural language and controlled vocabulary approach are two-fold:
    1. Newer articles will be added to the databases before they have been fully indexed and thesaurus terms applied. These will therefore not be found by a thesaurus term only search strategy
    2. Indexers, though they work to guidelines, are known to make mistakes. Again, incorrectly indexed articles will not be found by a thesaurus term only search strategy.
    See Wilczynski NL, Haynes RB. Consistency and accuracy of indexing systematic
    review articles and meta-analyses in medline. Health Info Libr J. 2009
    Sep;26(3):203-10. for a discussion of some of the issues

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